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A-Z Glossary

Table of Contents

Superior Limbic Keratoconjunctivitis

Vasudha Rao
Written byVasudha Rao
Vasudha Rao
Vasudha Rao4th Year Optometry Student, UC BerkeleyBerkeley, CA

Bio

Vasudha Rao is a fourth-year optometry student at the UC Berkeley School of Optometry with aspirations of specializing in ocular disease or community care. She is currently on clinical rotations. She enjoyed serving veterans at the Miami Veterans Affairs Hospital and learning from renowned clinicians at the Bascom Palmer Eye Institute as a part of her clinical training. Vasudha is passionate about helping underserved communities receive optometric care, and actively volunteers to provide vision screenings to those in need. In her spare time she enjoys partaking in a game of Scrabble, enhancing her cooking skills, and sharing her clinical cases on her Instagram page @visions.of.vasudha.

  • Last updated November 5, 2022

What is Superior Limbic Keratoconjunctivitis?

Superior limbic keratoconjunctivitis (SLK) is an inflammatory condition that affects the upper area of the cornea and conjunctiva. Superior limbic keratoconjunctivitis is highly associated with thyroid disease, but it may also be caused by dry eye or contact lens irritation. Symptoms of superior limbic keratoconjunctivitis are redness (especially of the upper portion of the conjunctiva), eye pain, and feeling like something is stuck inside of the eye. Treatment of superior limbic keratoconjunctivitis involves antibiotic drops and anti-inflammation drops/. 

Key Takeaways

  • Superior limbic keratoconjunctivitis is an inflammatory disorder that affects the superior cornea and conjunctiva.
  • Superior limbic keratoconjunctivitis is highly associated with thyroid disease.
  • Symptoms of superior limbic keratoconjunctivitis include redness, painful foreign body sensation, watery eyes, and light sensitivity. 
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Understanding Superior Limbic Keratoconjunctivitis

Superior limbic keratoconjunctivitis causes inflammation of the superior areas of the cornea and bulbar conjunctiva of the eye. It may be difficult to see this region of the eye unless you look down and pull up the upper eyelid. The cornea is the clear, dome-shaped outer coating of the eye. The bulbar conjunctiva is the clear lining over the white part of the eye. In superior limbic keratoconjunctivitis, the superior (top) area of the cornea and conjunctiva is affected. Inflammation causes the upper part of the bulbar conjunctiva, which is usually white, to look red and inflamed.  The rest of the conjunctiva is relatively white and unaffected.

Superior limbic keratoconjunctivitis predominantly affects middle-aged women between 30 to 60 years old. Although it usually affects both eyes, it may affect one eye more than the other. Approximately 30% to 50% of all people diagnosed with superior limbic keratoconjunctivitis  have hyperthyroidism. Therefore, if your eye doctor detects superior limbic keratoconjunctivitis, they will most likely order further lab testing to determine if you have thyroid disease. 

Symptoms of superior limbic keratoconjunctivitis include:

  • Feeling like there are rocks underneath the upper eyelid
  • Sensation of something stuck inside of the eye
  • Eye pain
  • Light sensitivity
  • Watering or tearing of the eyes
  • Excessive blinking

Physical Exam

When evaluating the eyes for superior limbic keratoconjunctivitis, the doctor checks for various signs that indicate the presence of inflammation. Signs of superior limbic keratoconjunctivitis include:

  • Redness located on the superior bulbar conjunctiva
  • Engorgement of the blood vessels in the conjunctiva
  • Papillae (tiny bumps) located on the inside of the upper eyelid
  • Extra folds of bulbar conjunctiva
  • Staining of bulbar conjunctiva with Rose bengal dye 

Testing 

Testing for superior limbic keratoconjunctivitis include: 

  • Slit lamp analysis: The eye tissues are assessed for redness and inflammation under the microscope.
  • Rose Bengal dye:  A pink dye is dabbed onto the front part of the eye, and it stains the area of inflammation pink. 
  • Other thyroid eye disease Tests: : Additional testing may be performed to evaluate if there is bulging of the eyes, decreased motility of the eye muscles, or dryness of the inferior cornea. These are other eye-related complications of thyroid disease.
  • Lab work for thyroid disease: The eye doctor may order tests for thyroid function including T3, T4, and TSH.

Thyroid disease occurs when the thyroid gland produces too much hormone (hyperthyroidism) or too little hormone (hypothyroidism). The thyroid gland is located at the front of the throat and produces hormones that regulate metabolism. Upto  50% of people diagnosed with superior limbic keratoconjunctivitis also have hyperthyroidism. Other systemic symptoms of hyperthyroidism include rapid heartbeat, anxiety, weight loss, increased appetite, sweating, and heat intolerance. 

Graves Disease is a form of hyperthyroidism due to overactivity of the thyroid gland. Graves Disease can affect the eyes by causing:

  • A ‘stare’ appearance due to eyelid retraction
  • Bulging of the eyes (exophthalmos)
  • Decreased eye muscle movement
  • Double vision
  • Eye pain
  • Optic nerve compression

Treatment

The treatment available for superior limbic keratoconjunctivitis varies based on the severity of inflammation. If the inflammation is mild, it can be treated with artificial tears. For moderate or severe cases, antibiotic drops and anti-inflammation drops are used. Some examples of anti-inflammation drops include: steroids, tacrolimus, vitamin A and cyclosporine. In rare cases, surgery may be required.

Bibliography

  1. “Superior Limbic Keratoconjunctivitis – about the Disease – Genetic and Rare Diseases Information Center.” Rarediseases.info.nih.gov, rarediseases.info.nih.gov/diseases/10940/superior-limbic-keratoconjunctivitis. Accessed 4 Aug. 2022.
  2. “Superior Limbic Keratoconjunctivitis | Columbia Ophthalmology.” Www.columbiaeye.org, www.columbiaeye.org/education/digital-reference-of-ophthalmology/cornea-external-diseases/non-infectious/superior-limbic-keratoconjunctivitis. Accessed 4 Aug. 2022.
  3. “Superior Limbic Keratoconjunctivitis (SLK): Background, Etiology and Pathophysiology, Pathophysiology.” EMedicine, 19 July 2021, emedicine.medscape.com/article/1194578-overview.

Related Terms

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Refractive Error

are the result of a mismatch between the eye’s focal power and axial length

Achromatopsia

is a retinal condition that results in the inability to see color

Scleral Lenses

are rigid gas permeable lenses (RGP) that vault over the cornea and rest on the sclera and conjunctival tissue

Canaliculus

is part of the nasolacrimal drainage system, which drains tears from the surface of the eye into the nasal cavity

Macula Lutea

also known as the macula, refers to the small area in the back of the eye that is responsible for central vision

Stye

is an inflamed oil gland on the margin of the eyelid around the eyelashes

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